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Agoubi LL, Banks S, Hink AB, Kuhls D, Kirkendoll SD, Winchester A, Hoeft C, Patel B, Nathens A. Community-Level Disadvantage of Adults With Firearm- vs Motor Vehicle-Related Injuries. JAMA Netw Open 2024; 7:e2419844. [PMID: 38967925 PMCID: PMC11227070 DOI: 10.1001/jamanetworkopen.2024.19844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/26/2024] [Indexed: 07/06/2024] Open
Abstract
Importance Motor vehicle crash (MVC) and firearm injuries are 2 of the top 3 mechanisms of adult injury-related deaths in the US. Objective To understand the differing associations between community-level disadvantage and firearm vs MVC injuries to inform mechanism-specific prevention strategies and appropriate postdischarge resource allocation. Design, Setting, and Participants This multicenter cross-sectional study analyzed prospectively collected data from the American College of Surgeons (ACS) Firearm Study. Included patients were treated either for firearm injury between March 1, 2021, and February 28, 2022, or for MVC-related injuries between January 1 and December 31, 2021, at 1 of 128 participating ACS trauma centers. Exposures Community distress. Main outcome and Measure Odds of presenting with a firearm as compared with MVC injury based on levels of community distress, as measured by the Distressed Communities Index (DCI) and categorized in quintiles. Results A total of 62 981 patients were included (mean [SD] age, 42.9 [17.7] years; 42 388 male [67.3%]; 17 737 Black [28.2%], 9052 Hispanic [14.4%], 36 425 White [57.8%]) from 104 trauma centers. By type, there were 53 474 patients treated for MVC injuries and 9507 treated for firearm injuries. Patients with firearm injuries were younger (median [IQR] age, 31.0 [24.0-40.0] years vs 41.0 [29.0-58.0] years); more likely to be male (7892 of 9507 [83.0%] vs 34 496 of 53 474 [64.5%]), identified as Black (5486 of 9507 [57.7%] vs 12 251 of 53 474 [22.9%]), and Medicaid insured or uninsured (6819 of 9507 [71.7%] vs 21 310 of 53 474 [39.9%]); and had a higher DCI score (median [IQR] score, 74.0 [53.2-94.8] vs 58.0 [33.0-83.0]) than MVC injured patients. Among admitted patients, the odds of presenting with a firearm injury compared with MVC injury were 1.50 (95% CI, 1.35-1.66) times higher for patients living in the most distressed vs least distressed ZIP codes. After controlling for age, sex, race, ethnicity, and payer type, the DCI components associated with the highest adjusted odds of presenting with a firearm injury were a high housing vacancy rate (OR, 1.11; 95% CI, 1.04-1.19) and high poverty rate (OR, 1.17; 95% CI, 1.10-1.24). Among patients sustaining firearm injuries patients, 4333 (54.3%) received no referrals for postdischarge rehabilitation, home health, or psychosocial services. Conclusions and Relevance In this cross-sectional study of adults with firearm- and motor vehicle-related injuries, we found that patients from highly distressed communities had higher odds of presenting to a trauma center with a firearm injury as opposed to an MVC injury. With two-thirds of firearm injury survivors treated at trauma centers being discharged without psychosocial services, community-level measures of disadvantage may be useful for allocating postdischarge care resources to patients with the greatest need.
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Affiliation(s)
- Lauren L. Agoubi
- Harborview Injury Prevention and Research Center and the Department of Surgery, University of Washington, Seattle
| | - Samantha Banks
- Firearm Injury and Policy Research Program, University of Washington, Seattle
| | - Ashley B. Hink
- Department of Surgery, Medical University of South Carolina, Charleston
| | - Deborah Kuhls
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas
| | - Shelbie D. Kirkendoll
- Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois
- American College of Surgeons
| | | | | | | | - Avery Nathens
- American College of Surgeons
- Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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Silver JH, Ramos TA, Stamm MA, Gladden PB, Martin MP, Mulcahey MK. Examining the Healthcare and Economic Burden of Gun Violence in a Major US Metropolitan City. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202308000-00005. [PMID: 37561926 PMCID: PMC10412425 DOI: 10.5435/jaaosglobal-d-22-00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 04/06/2023] [Accepted: 05/31/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION The highest rates of fatal and nonfatal injury due to firearms occur in the Southern United States. This study examined the epidemiology of gunshot wound (GSW) injuries and the association of injury severity with mortality. METHODS This is a retrospective cross-sectional analysis of 2016 to 2019 data from a mandatory reporting system for all licensed hospitals in Louisiana. Patients aged 18 years and older at the time of hospitalization for GSW were included. Injury severity was measured by the New Injury Severity Score (NISS). Primary outcomes assessed included mortality, length of stay, and total hospital charges. RESULTS There were 1,709 firearm injuries identified. The patient sample was 83.2% Black and 87.4% male, with a mean age of 34 years. Orthopaedics was the most frequently consulted surgical service. Total hospital visit charges for all GSW-associated care were $262.4 million. The multivariable adjusted odds ratio and 95% confidence interval for mortality associated with a high NISS was 16.32 (8.96, 29.72). CONCLUSION This study demonstrated the utility of NISS as a predictor of total hospital charges and length of stay, in addition to its well-established role as a predictor of mortality. Epidemiologic trends in GSW pathologies and associated procedures at a major urban trauma center were also reported. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Julia H Silver
- Tulane University School of Medicine, New Orleans, LA (Dr. Silver and Dr. Ramos); the Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA (Ms. Stamm, Dr. Gladden, Dr. Martin, Dr. Mulcahey)
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Agoubi LL, Duan N, Rowhani-Rahbar A, Nehra D, Sakran JV, Rivara FP. Patterns in Location of Death From Firearm Injury in the US. JAMA Surg 2023; 158:669-670. [PMID: 37017980 PMCID: PMC10077128 DOI: 10.1001/jamasurg.2022.8380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/12/2022] [Indexed: 04/06/2023]
Abstract
This cross-sectional study assesses non–self-inflicted firearm-related deaths occurring at inpatient or outpatient facilities, hospice care, nursing homes, home, or other settings from 1999 to 2021.
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Affiliation(s)
- Lauren L. Agoubi
- Department of Surgery, University of Washington School of Medicine, Seattle
- Harborview Injury Prevention and Research Center, Seattle, Washington
| | - Ning Duan
- Harborview Injury Prevention and Research Center, Seattle, Washington
- Firearm Injury and Policy Research Program, University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Firearm Injury and Policy Research Program, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Joseph V. Sakran
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia
| | - Frederick P. Rivara
- Harborview Injury Prevention and Research Center, Seattle, Washington
- Firearm Injury and Policy Research Program, University of Washington, Seattle
- Department of Pediatrics, University of Washington, Seattle
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Population-Based Assessment of Urban Versus Rural Child Fatalities From Firearms in a Midwestern State. J Surg Res 2023; 283:52-58. [PMID: 36370682 DOI: 10.1016/j.jss.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/22/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Several studies have evaluated differences in firearm injury patterns among children based on regionalization. However, many of these studies exclude patients who die before arriving at a trauma center. We therefore hypothesize that important population-based differences in pediatric firearm injuries may be uncovered with the inclusion of both prehospital firearm mortalities and patients treated at a tertiary children's hospital. METHODS Patients less than 15 y of age who sustained a firearms-related injury/death between the years 2012 and 2018 were identified in: (1) death certificates from the Office of Vital Statistics State of Indiana and (2) Riley Hospital for Children at Indiana University Health Trauma Registry. Counties of injury were classified as either urban, midsized, or rural based on the National Center for Health Statistic's population data. Significant variables in univariate analysis were then assessed using multivariate logistic regression models. RESULTS A total of 222 patients were identified. Median age of firearm injury survivors was 13 (interquartile range 7-14), while the median age of nonsurvivors was 14 (interquartile range 11-15), P = 0.040. The proportion of suicide was significantly higher in rural counties (P < 0.001). When controlling for shooter intent, patients from a rural or midsized county had statistically significant higher odds of dying before reaching a hospital than their urban counterpart (rural odds ratio [OR] 5.67 [95% confidence interval {CI} 2.23, 14.38]; midsized OR 6.53 [95% CI 2.43, 17.46]; P < 0.001). CONCLUSIONS Important differences exist between pediatric firearm injuries based on where they occur. Public health initiatives aimed at reducing pediatric firearm injury and death should not exclude rural pediatrics patients.
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Theodorou CM, Beyer CA, Vanover MA, Brown IE, Salcedo ES, Farmer DL, Hirose S, Beres AL. The hidden mortality of pediatric firearm violence. J Pediatr Surg 2022; 57:897-902. [PMID: 35093255 DOI: 10.1016/j.jpedsurg.2021.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Firearms and motor vehicle collisions (MVC) are leading causes of mortality in children. We hypothesized that firearm injuries would have a higher mortality than MVCs in children and a higher level of resource utilization METHODS: Trauma patients <18 years old at a Level 1 pediatric trauma center sustaining gunshot wounds (GSW) or MVCs 2009-2019 were included. The primary outcome was mortality. The secondary outcome was immediate surgery. The California Department of Public Health's Overall Injury Surveillance tool was queried for patients <18 with GSW or MVC 2006-2015 to compare statewide case fatality rates (CFRs), and analyze proportions of GSWs by intent: assault, self-inflicted, and unintentional. RESULTS Of 13,840 pediatric trauma patients at our institution, 295 GSWs (2.1%) and 4467 MVCs (32.3%) were included. Mortality was higher for GSWs (7.5% vs. 0.8%, p<0.0001). GSW patients were more likely to require immediate surgery (34.4% vs. 11.2%, p<0.0001). On multivariable analysis, GSW patients were 7.8-times more likely to die than MVC patients (OR 7.83, 95% CI 3.68-16.66, p<0.0001), adjusted for age, sex, and injury severity. Statewide, there were 10,790 pediatric GSWs with 1586 deaths (CFR 14.7%) vs. 710 deaths in 261,363 children in MVCs (CFR 0.3%, p<0.0001). The GSW CFR rose (13.4% to 16.5%, p = 0.05) while the MVC CFR decreased (0.5% to 0.2%, p<0.0001) in 2015 vs. 2006. CONCLUSION Firearm violence in pediatric patients is significantly more lethal than MVCs and is resource intensive. The case fatality rate for pediatric firearm violence is rising. Resources must be directed at preventing pediatric firearm injuries. LEVEL OF EVIDENCE Prognosis study, Level II.
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Affiliation(s)
| | - Carl A Beyer
- Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | | | - Ian E Brown
- Department of Surgery, Division of Trauma, Acute Care Surgery, and Surgical Critical Care, UC Davis Medical Center, Sacramento, CA, USA
| | - Edgardo S Salcedo
- Department of Surgery, Division of Trauma, Acute Care Surgery, and Surgical Critical Care, UC Davis Medical Center, Sacramento, CA, USA
| | - Diana L Farmer
- Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Shinjiro Hirose
- Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Alana L Beres
- Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, CA, USA
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Cai Z, Junus A, Chang Q, Yip PSF. The lethality of suicide methods: A systematic review and meta-analysis. J Affect Disord 2022; 300:121-129. [PMID: 34953923 DOI: 10.1016/j.jad.2021.12.054] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The use of suicide methods largely determines the outcome of suicide acts. However, no existing meta-analysis has assessed the case fatality rates (CFRs) by different suicide methods. The current study aimed to fill this gap. METHODS We searched Scopus, Web of Science, PubMed, ProQuest and Embase for studies reporting method-specific CFRs in suicide, published from inception to 31 December 2020. A random-effect model meta-analysis was applied to compute pooled estimates. RESULTS Of 10,708 studies screened, 34 studies were included in the meta-analysis. Based on the suicide acts that resulted in death or hospitalization, firearms were found to be the most lethal method (CFR:89.7%), followed by hanging/suffocation (84.5%), drowning (80.4%), gas poisoning (56.6%), jumping (46.7%), drug/liquid poisoning (8.0%) and cutting (4.0%). The rank of the lethality for different methods remained relatively stable across study setting, sex and age group. Method-specific CFRs for males and females were similar for most suicide methods, while method-CFRs were specifically higher in older adults. CONCLUSIONS This study is the first meta-analysis that provides significant evidence for the wide variation of the lethality of suicide methods. Restricting highly lethal methods based on local context is vital in suicide prevention.
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Affiliation(s)
- Ziyi Cai
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Alvin Junus
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Qingsong Chang
- School of Sociology and Anthropology, Xiamen University, Xiamen, China.
| | - Paul S F Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China; Hong Kong Jockey Club Center for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China.
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Lasky T, Richmond BK, Samanta D, Annie F. A 10-Year Review of Spatio-Temporal Patterns of Firearm Injury in a Rural Setting. Am Surg 2021; 88:834-839. [PMID: 34866416 DOI: 10.1177/00031348211054559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION West Virginia (WV) had the ninth highest rate of firearm mortality of all states in the United States according to the CDC in 2018. Gun violence in WV has been a steady problem over the last decade. The rural population is more vulnerable to unintentional firearm injuries and suicides. Previously published literature from urban settings has demonstrated a link between firearm injuries and modifiable situational variables such as crime, unemployment, low income, and low education. There are very few studies that have utilized geospatial analytic techniques as a tool for injury mapping, surveillance, and primary prevention in rural and frontier zones of the United States. METHODS We performed a 10-year retrospective single-institution review of firearm injuries at a rural WV level 1 trauma center between January 2010 and December 2019. The AIS World Geocoding Service was then used to identify specific areas of emerging firearm-related injuries within the service area. RESULTS Specific hot spots of emerging firearm injury were identified in both intentional and unintentional populations. These were located in geographically distinct areas of the WV unincorporated rural and frontier population. These rural WV hotspots were associated with the modifiable variables of crime, unemployment, lower income, and lower education level. CONCLUSIONS Emerging hot spots of firearm injury in rural and frontier locations were associated with modifiable social determinants. These areas represent an opportunity for targeted injury prevention efforts addressing these disparities. Further prospective study of these findings is warranted.
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Affiliation(s)
- Tiffany Lasky
- West Virginia University School of Medicine-Charleston Division, Department of Surgery, 37297Charleston Area Medical Center, Charleston, WV, USA
| | - Bryan K Richmond
- West Virginia University School of Medicine-Charleston Division, Department of Surgery, 37297Charleston Area Medical Center, Charleston, WV, USA
| | - Damayanti Samanta
- Center for Health Services and Outcomes Research, 20205Charleston Area Medical Center Institute for Academic Medicine, Charleston, WV, USA
| | - Frank Annie
- Center for Health Services and Outcomes Research, 20205Charleston Area Medical Center Institute for Academic Medicine, Charleston, WV, USA
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Fraser Doh K, Sheline E, Wetzel M, Simon HK, Morris CR. Comparison of cost and resource utilization between firearm injuries and motor vehicle collisions at pediatric hospitals. Acad Emerg Med 2021; 28:630-638. [PMID: 33599028 DOI: 10.1111/acem.14234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/31/2021] [Accepted: 02/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Firearm injuries are converging with motor vehicle collisions (MVC) as the number one cause of death for children in the United States. Thus we examine differences in hospital cost and hospital resource utilization between motor vehicle and firearm injury. METHODS This retrospective, cross-sectional study compares hospital costs and resource utilization of motor vehicle and firearm-injured children aged 0 to 19 years of age over a 5-year time frame (January 1, 2013-December 31, 2017) in 35 freestanding children's hospitals that submitted data to the Pediatric Health Information System. The primary outcome was hospital-adjusted comparative cost per patient presentation. Generalized linear mixed models were used to quantify the relationship between the type of injury and each outcome, adjusting for patient characteristics and hospital. RESULTS There were 89,133 emergency department (ED) visits attributed to MVCs and 3,235 for firearm injury. Of the youths who presented for firearm injury, 49% were hospitalized versus 14% of youths presenting with MVC (adjusted odds ratio [aOR] = 6.6, 95% confidence interval [CI] = 6.1 to 7.2). Youths with firearm injury were more likely to be admitted to an intensive care unit (aOR = 6.7, 95% CI = 5.9 to 7.7) and had longer lengths of stays (aOR = 2.2, 95% CI = 1.9 to 2.6) compared to their MVC counterparts. Children admitted for firearm injury had more imaging and ED return visits, along with subsequent inpatient admission within 3 days (aOR = 3.4, 95% CI = 2.1 to 5.5) and 1 year (aOR = 2.5, 95% CI = 2.1 to 2.9). The mean relative per-patient costs were nearly fivefold higher for the firearm-injured group. CONCLUSIONS Hospital costs and markers of resource utilization were higher for youths with firearm injury compared to MVC. High medical resource utilization is one of several important reasons to advocate for a comparable national focus and funding on firearm-related injury prevention.
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Affiliation(s)
- Kiesha Fraser Doh
- Departments of Pediatrics and Emergency Medicine Emory University School of Medicine Atlanta Georgia USA
- Children's Healthcare of Atlanta Atlanta Georgia USA
| | - Erica Sheline
- Department of Pediatrics University of Colorado School of Medicine Aurora Colorado USA
| | - Martha Wetzel
- Department of Pediatrics Biostatistics Core Emory University School of Medicine Atlanta Georgia USA
| | - Harold K. Simon
- Departments of Pediatrics and Emergency Medicine Emory University School of Medicine Atlanta Georgia USA
- Children's Healthcare of Atlanta Atlanta Georgia USA
| | - Claudia R. Morris
- Departments of Pediatrics and Emergency Medicine Emory University School of Medicine Atlanta Georgia USA
- Children's Healthcare of Atlanta Atlanta Georgia USA
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Kalesan B, Siracuse JJ, Cook A, Prosperi M, Fagan J, Galea S. Prevalence and hospital charges from firearm injuries treated in US emergency departments from 2006 to 2016. Surgery 2020; 169:1188-1198. [PMID: 33384161 DOI: 10.1016/j.surg.2020.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Age- and intent-related differences in the burden and costs of firearm injury treated in emergency departments are not well-documented. METHODS We performed a serial cross-sectional study of the Healthcare Cost and Utilization Program Nationwide Emergency Department Survey from 2006 to 2016. We used International Classification of Diseases diagnoses codes revisions 9 and 10 to identify firearm injuries. We calculated survey-weighted counts, proportions, means, and rates and confidence intervals of national, age-specific (0-4, 5-9, 10-14, 15-17, 18-44, 45-64, 65-84, >84) and intent-specific (assault, unintentional, suicide, undetermined) emergency department discharges for firearm injuries. We used survey-weighted regression to assess temporal trends. RESULTS There was a total of 868,483 (25.5 per 100,000) emergency department visits for firearm injuries from 2006 to 2016, and 7.8% died in the emergency department. Overall, firearm injury rates remained steady (P = .78). The largest burden was among those 25 to 44 years of age, but their rates remained stable (10.8 per 100,000). Overall assault injuries declined from 39.7% to 36.4%, and overall unintentional injuries increased from 46.4% to 54.7%. Legal-intervention injuries declined from 0.6 to 0.3 per 100,000. The charges (total $4,059,070,364, $369,006,396/year) increased across time in age and intent groups. The mean predicted charges increased from $1,922 to $3,348 in those alive versus $3,741 to $6,515 among those who died. CONCLUSION Interventions and programs to manage the consequences of firearm injury in persons who live with ongoing morbidity and economic burden are warranted.
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Affiliation(s)
- Bindu Kalesan
- Department of Medicine and Community Health Sciences, Boston University School of Medicine and Public Health, MA.
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine and Boston Medical Center, MA
| | - Alan Cook
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at Tyler, UT Health East Texas Level I Trauma Center, TX
| | | | - Jeffrey Fagan
- Department of Epidemiology and Law, Mailman School of Public Health and School of Law, Columbia University, New York, NY
| | - Sandro Galea
- Dean's Office, Boston University School of Public Health, MA
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Spitzer SA, Pear VA, McCort CD, Wintemute GJ. Incidence, Distribution, and Lethality of Firearm Injuries in California From 2005 to 2015. JAMA Netw Open 2020; 3:e2014736. [PMID: 32845330 PMCID: PMC7450357 DOI: 10.1001/jamanetworkopen.2020.14736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Little is known about nonfatal firearm injuries in the United States, and national estimates based on emergency department samples may not be accurate. OBJECTIVE To describe the incidence and distribution of nonfatal firearm injuries and estimate case fatality ratios (CFRs) for firearm injuries by external cause of injury code within California overall and by race/ethnicity, including an assessment of trends over time and geographic variation within the state. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study used complete statewide data for firearm-related mortality, emergency department visits, and hospitalizations among California residents from January 1, 2005, through December 31, 2015, to analyze incidence, distribution, and CFRs of firearm injury. Data were analyzed from 2018 to 2019. EXPOSURES All individuals in California with a firearm injury based on International Classification of Diseases, Ninth Revision or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes were included. MAIN OUTCOMES AND MEASURES Counts and rates of nonfatal firearm injuries overall and stratified by external cause, sex, and race/ethnicity; total and clinical CFRs. Clinical CFR was calculated based on individuals treated in emergency departments or hospitals. RESULTS Over the study period, there were 81 085 firearm-related emergency department visits and hospitalizations among individuals with a mean (SD) age of 27.5 (11.9) years, 72 567 (89.6%) of whom were men. Nonfatal firearm injuries in California decreased by 38.1% between 2005 and 2015, driven by a 46.4% decrease in assaultive injuries. Self-inflicted injuries and unintentional injuries remained relatively stable. The overall CFR for firearm injuries increased from 27.6% in 2005 to 32.2% in 2015 for a relative increase of 20.7%, while the clinical CFR remained stable between 7.0% and 9.0%. CONCLUSIONS AND RELEVANCE These findings suggest that although the number of firearm injuries has decreased in California, the lethality of these injuries has not. Similar studies from other states could provide more information about these trends nationwide.
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Affiliation(s)
- Sarabeth A. Spitzer
- Now with the Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- University of California Firearm Violence Research Center, Sacramento
| | - Veronica A. Pear
- University of California Firearm Violence Research Center, Sacramento
- Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento
| | - Christopher D. McCort
- University of California Firearm Violence Research Center, Sacramento
- Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento
| | - Garen J. Wintemute
- University of California Firearm Violence Research Center, Sacramento
- Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento
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Covington HE, Newman EL, Leonard MZ, Miczek KA. Translational models of adaptive and excessive fighting: an emerging role for neural circuits in pathological aggression. F1000Res 2019; 8:F1000 Faculty Rev-963. [PMID: 31281636 PMCID: PMC6593325 DOI: 10.12688/f1000research.18883.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/16/2022] Open
Abstract
Aggression is a phylogenetically stable behavior, and attacks on conspecifics are observed in most animal species. In this review, we discuss translational models as they relate to pathological forms of offensive aggression and the brain mechanisms that underlie these behaviors. Quantifiable escalations in attack or the development of an atypical sequence of attacks and threats is useful for characterizing abnormal variations in aggression across species. Aggression that serves as a reinforcer can be excessive, and certain schedules of reinforcement that allow aggression rewards also allow for examining brain and behavior during the anticipation of a fight. Ethological attempts to capture and measure offensive aggression point to two prominent hypotheses for the neural basis of violence. First, pathological aggression may be due to an exaggeration of activity in subcortical circuits that mediate adaptive aggressive behaviors as they are triggered by environmental or endogenous cues at vulnerable time points. Indeed, repeated fighting experiences occur with plasticity in brain areas once considered hardwired. Alternatively, a separate "violence network" may converge on aggression circuitry that disinhibits pathological aggression (for example, via disrupted cortical inhibition). Advancing animal models that capture the motivation to commit pathological aggression remains important to fully distinguish the neural architecture of violence as it differs from adaptive competition among conspecifics.
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Affiliation(s)
- Herbert E. Covington
- Department of Psychology, Tufts University, Medford, 530 Boston Ave, 02155, MA, USA
| | - Emily L. Newman
- Department of Psychology, Tufts University, Medford, 530 Boston Ave, 02155, MA, USA
| | - Michael Z. Leonard
- Department of Psychology, Tufts University, Medford, 530 Boston Ave, 02155, MA, USA
| | - Klaus A. Miczek
- Department of Psychology, Tufts University, Medford, 530 Boston Ave, 02155, MA, USA
- Department of Neuroscience, Tufts University, Boston, 136 Harrison Ave, 02111, MA, USA
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